Children and Disasters

Issue #5: February 3, 2014

NEWS

  • POISONING THE WELL – On January 9 chemicals were discovered leaking from a coal industry storage facility into West Virginia’s Elk River, just upstream from the source of Charleston’s drinking water. By now most of the toxic spill has washed downstream. All along the river we are left with questions. Do we have a complete list of the spilled chemicals? Are there short or long term toxic effects? Will we learn anything from the accident by tracking biomarkers of toxic exposures and conducting surveillance of their effects? Do we have the public health infrastructure, the authority, or the interest to gather such information? How many other communities’ water supply is so vulnerable to contamination? In West Virginia, the Centers for Disease Control says, “pregnant women may wish to consider an alternative drinking water source” and “for mothers with babies, there is no research that suggests consuming water with these low levels of methylcyclohexanemethanol poses any health risk to their baby. However, if you have any concerns, please consult your doctor.” Unfortunately, it is not so clear where a physician would obtain information to answer parents’ questions about child safety after toxic exposures. Among tens of thousands of chemicals present in the environment, we have data about human health effects for few of them. Scientific observations are especially difficult to obtain and report when concern for safety competes with business interests. Infants and children may be especially vulnerable. Obsolete safety regulations make it uncertain that we will be able to prevent such accidents from recurring. Would we be more alert to the hazard if the spill could be attributed to a terrorist attack rather than an industrial accident?
  • NEW COLLEGE – Governor Cuomo has proposed the creation of a new college in New York State dedicated to training for emergency preparedness and homeland security.

TOOLS

  • INFOGRAPHIC – The DelValle Institute for Emergency Preparedness has summarized responses and recovery services after the April Boston bombing. Hospitals were notified of the attack in less than 10 minutes. 41% of critical patients were transported in half an hour; all in less than one hour.
  • UNIVERSITY OF ARIZONA CENTER FOR CLIMATE ADAPTATION SCIENCE AND SOLUTIONS – See the CCASS website for research on climate change and information needs for decision makers.

SCIENCE

  • PEDIATRIC TRIAGE IN A MASS CASUALTY EVENT – Emergency and critical care resources may be overwhelmed by a surge of patients that exceeds available resources. Usual standards of care provide virtually unlimited resources attempting to maximize the survival of each individual. Lacking rules to guide triage in a major emergency, providers would care for patients on a first-come-first-served basis until resources were exhausted. Subsequent patients would receive little treatment. In a large  emergency, proposed crisis standards of care would maximize population outcomes by triaging acute care to those most likely to benefit from simple interventions, while providing palliative care to the most severely ill or injured whose complex resuscitation would deprive many others of lifesaving but simple care. The difficulty is that we lack evidence to rapidly identify the high priority patients who should receive critical care. The evidence basis for pediatric triage is especially inadequate. The existence of detailed clinical information in large patient registries provides the opportunity to gain insight about early identification of patients who are likely to survive as a result of brief and simple critical care interventions. At the 2014 Society for Critical Care Medicine meeting, Dr. Phil Toltzis and colleagues reported preliminary work on empirical models for pediatric triage that might improve patient selection to optimize population outcomes in a major emergency.

Edited byDr. Bob Kanter

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